Long-term outcomes of Ahmed glaucoma valve implantation in glaucoma patients

Long-term outcomes of Ahmed glaucoma valve implantation in glaucoma patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Long-term outcomes of Ahmed glaucoma valve implantation in glaucoma patients Bo Yu, Muyao Xin, Yu Sun, Junran Li, Emmanuel Eric Pazo, Xiaoli Xing This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6495663/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Aug, 2025 Read the published version in BMC Ophthalmology → Version 1 posted 10 You are reading this latest preprint version Abstract Background To evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation in treating refractory glaucoma and analyze the factors influencing the surgical success rate. Methods A 5-year retrospective analysis was conducted on 199 patients with neovascular glaucoma, secondary glaucoma (excluding neovascular types), and residual glaucoma treated with AGV, model FP7. Preoperative and postoperative data, including intraocular pressure (IOP), visual acuity, and surgical outcomes, were analyzed. Results Complete Success rates were 60.5%, 56%, and 39.3% at years 1, 3, and 5, respectively. Overall success rates were 83%, 74.7%, and 67.9% at the same intervals. Visual acuity (VA) showed statistically significant improvement at year 1 (P 0.05). Low preoperative IOP and the history of pan-retinal photocoagulation (PRP) were identified as protective factors contributing to the success of surgical outcomes at year-1. Conclusion AGV implantation is a safe and effective treatment for neovascular glaucoma. Preoperative IOP and a history of PRP significantly influence surgical success at one year, with success rates declining over 5 years. Careful surgical execution is crucial for achieving optimal outcomes. Trial registration: This retrospective study was registered at the registered in Chinese Clinical Trial Register (ChiCTR2400089879). Glaucoma Ahmed glaucoma valve Neovascular glaucoma Secondary glaucoma Residual glaucoma Glaucoma surgical success rate Figures Figure 1 Figure 2 Figure 3 1. Background Glaucoma is a prominent contributor to permanent vision loss on a global scale, with the potential to impact as many as 111 million individuals worldwide by 2040[ 1 – 3 ]. It includes a diverse range of disorders that result in permanent loss of vision. These conditions are characterized by a gradual decline in retinal ganglion cells (RGCs) and damage to the optic nerve, in most cases accompanied by increased pressure within the eye[ 4 , 5 ]. Due to the gradual deterioration of vision, the common imbalance of illness between the eyes, and the neurological processes that compensate for regions of visual loss, patients typically remain unconscious of their declining eyesight until the latter stages of the disease[ 6 – 8 ]. A staggering proportion of glaucoma cases, remain undiagnosed in low-income and middle-income nations, while around half of the cases go undetected in high-income ones[ 1 , 9 ]. Glaucoma, the primary cause of permanent blindness worldwide, affects most patients but does not always result in complete loss of vision. Treatment for glaucoma is successful in reducing the speed at which vision deteriorates. However, there are no therapies available to restore eyesight that has been lost due to glaucoma[ 10 , 11 ]. Therefore, it is crucial to identify cases and provide efficient therapy. The incidence of glaucoma is expected to significantly increase in the future because to the aging population. Consequently, there will be a greater need for improved identification and treatment of glaucoma to prevent avoidable blindness[ 12 , 13 ]. Surgical intervention is a widely established approach for the management of glaucoma. In concert with technological progress, there has been a significant expansion in the development of intraocular implants, which are designed to efficiently lower intraocular pressure[ 14 ]. The Ahmed glaucoma valve (AGV) is a surgically implanted drainage valve that is designed to regulate the flow of fluid in the eye. It is made up of thin membranes made of silicone elastomer that open and shut in response to changes in intraocular pressure (IOP). This helps to prevent the occurrence of low eye pressure after surgery[ 15 , 16 ]. Trabeculectomy and glaucoma drainage device implantation are the predominant glaucoma procedures done on a global scale. While trabeculectomy is considered the most effective method, there is now a growing trend in the use of glaucoma drainage devices. The Ahmed glaucoma valve is a very prevalent glaucoma drainage device that is used extensively on a global scale[ 17 ].Therefore, the purpose of this study was to evaluate the long-term effect of AGV on refractory glaucoma patients. 2. Methods 2.1 Participants and study design We conducted a retrospective analysis of medical records from patients diagnosed with neovascular glaucoma, secondary glaucoma (excluding neovascular types), and residual glaucoma, all of whom were treated with the AGV (model: FP7, New World Medical Inc., Rancho Cucamonga, CA, USA) at Tianjin Medical University Eye Hospital in China, from January 2016 to June 2023. The study included all patients clinically diagnosed with glaucoma and underwent AGV implantation. Additional inclusion criteria comprised: completed at least one year follow-up assessment, and the absence of serious systemic or mental disorders, aside from primary glaucoma (Fig. 1 ). 2.2 Surgical technique All procedures were performed by the same experienced glaucoma surgeon (XXL). The surgical process proceeded as outlined: (i) 2.5 ml of 2% lidocaine (Anhui Changjiang Pharmaceutical Co. Ltd, Wuhu, China) was administered for peribulbar anesthesia. (ii) A suspension wire was fashioned in the corneal limbus, and the bulbar conjunctiva superior to the temple was incised along the corneal limbus, resulting in the formation of a fornix-based conjunctival flap to reveal two rectus muscles. A pocket was created between the episclera and Tenon's capsule using blunt dissection. Following the separation of the fascia, hemostasis was achieved with cauterization. A 4x4 mm scleral flap with a thickness of 50% was created superior to the temple. (iii) The valve tube was irrigated with a balanced saline solution to activate the valve mechanism. The Ahmed valve (model: FP7) was subsequently positioned between the lateral rectus and superior rectus muscles, with a 6 − 0 suture secured 10 mm posterior to the corneal limbus. (iv) A lateral corneal incision was performed, sodium hyaluronate was administered into the anterior chamber, and an anterior chamber puncture was executed at the corneal limbus beneath the scleral flap. The drainage tube was introduced into the anterior chamber via the puncture site. (v) The sclera flap was secured with 10 − 0 suture, the drainage tube was anchored and partially ligated with one stitch of 8 − 0 absorbable suture, and the conjunctival flap was sutured. Similar to Mao et al.[ 18 ], procedure was deemed complete success, if the long-term IOP was ≤ 21 mmHg without the use of glaucoma medications or additional filtration surgery throughout the entire follow-up period. It was classified as a qualified success, if the IOP ≤ 21 mmHg was achieved with adjunctive medications, and as a failure, if the IOP exceeded 21 mmHg with medications, if further surgery was necessitated, if there was a loss of vision to no light perception (NLP), or if phthisis bulbi ensued. 2.3 Data collection Preoperative data were extracted from patient records and included age at surgery, gender, eye laterality, best-corrected visual acuity (BCVA), mean IOP over the three months preceding the surgery, history of prior ocular surgeries or laser interventions, specific glaucoma diagnosis and ocular history, and other co-morbidities. 2.4 Statical analysis Statistical analyses were performed using SPSS software (version 25.0, SPSS Inc., Chicago, IL). Continuous variables were expressed as mean ± standard deviation (SD). Preoperative and postoperative data were compared using paired, two-tailed Student’s t-tests, while unpaired, two-tailed Student’s t-tests were applied for independent continuous variables. Nonparametric variables were analyzed using Chi-square tests. Logistic regression analysis was conducted to identify factors influencing the surgical success rate. P < 0.05 was considered statistically significant. 3. Results 3.1 Baseline characteristics Table 1 illustrates the baseline characteristics of the patients enrolled in this study. The final analysis encompassed 199 eyes, with a distribution of 119 eyes from male patients and 80 eyes from female patients.Their mean age at the time of surgery was 55.06 ± 12.23 years, 42.23 ± 17.98 years and 57.09 ± 12.06 years for the neovascular, secondary and residual glaucoma respectively. The mean pre-operative IOP was 39.95 ± 11.93 mmHg, 33.95 ± 12.00 mmHg and 30.80 ± 9.84 mmHg among neovascular, secondary and residual glaucoma respectively. The difference between the mean baseline IOP and the IOP at each follow-up point was statistically significant ( P < 0.05) (Fig. 2 ). The mean change in VA between the pre-operative and post-operative groups at year-1, year-3 and year-5 were shown in Fig. 3 . Statistically significant changes were observed in year-1 ( P 0.05). Table 1 Basic data of enrolled patients Characteristics Groups Neovascular glaucoma (n = 134) Secondary glaucoma (n = 22) Residual glaucoma (n = 43) Gender Male 86 (64.2%) 12 (54.5%) 21 (48.8%) Female 48 (35.8%) 10 (45.5%) 22 (51.2%) Age (Year) 55.06 ± 12.23 42.23 ± 17.98 57.09 ± 12.06 Eye Left 75 (56.0%) 8 (36.4%) 16 (37.2%) Right 59 (44.0%) 14 (63.6%) 27 (62.8%) Pre-op VA 0.07 ± 0.13 0.15 ± 0.20 0.29 ± 0.28 Pre-op IOP (mmHg) 39.95 ± 11.93 33.95 ± 12.00 30.80 ± 9.84 Previous history Vitrectomy 42 (31.3%) 4 (18.2%) 6 (14.0%0 Cataract surgery 59 (44.0%) 14 (63.6%) 33 (76.7%) PRP 71 (53.0%) 6 (27.3%) 8 (18.6%) DM 112 (83.6%) 5 (22.7%) 10 (23.3%) HBP 65 (48.5%) 5 (22.7%) 15 (34.9%) Primary disease DR 102 (76.1%) NA NA RVO 13 (9.7%) NA NA OIS 7 (5.2%) NA NA Uveitis NA 9 (40.9%) NA High myopia NA 4 (18.2%) NA Ocular trauma NA 2 (9.1%) NA Uncertain 12 7 (31.8%) NA The complete success rates among all participants were 60.5% at year 1, 56% at year 3, and 39.3% at year 5. The overall success rates were 83%, 74.7%, and 67.9% at year 5. At year 1, the complete success rates for neovascular glaucoma, secondary glaucoma, and residual glaucoma were 63.7%, 62.8%, and 59.3%, respectively. The overall success rates for these subgroups at year 1 were 86.4%, 86%, and 81.5% respectively. One-year post-operative complications between the three groups is illustrated in Table 2 . Residual glaucoma was experienced by 11.6% in the residual glaucoma group, making is the highest frequency among all the complication while the neovascular and secondary glaucoma group experienced 9.0% and 9.1% respectively among the various groups. Furthermore, malignant glaucoma was only observed in the residual glaucoma group. Complications directly related to the implanted device such as drainage tube exposure was not observed in the residual glaucoma group and drainage tube displacement was not observed in the secondary glaucoma group. Table 2 Post-operation complications within 1 year Complictions Neovascular glaucoma (n = 134) Secondary glaucoma (n = 22) Residual glaucoma (n = 43) Choroidal detachment 5 (3.7%) 0 2 (4.7%) Drainage tube exposure 9 (6.7%) 2 (9.1%) 0 Drainage tube displacement 2 (1.5%) 0 2 (4.7%) Malignant glaucoma 0 0 2 (4.7%) Table 3 displays the regression analysis of factors for failure. Factors such as age, gender, diagnosis, pre-operative VA, pre-operative IOP, AGV combined with cataract surgery, history of panretinal photocoagulation (PRP), history of vitrectomy, history of cataract surgery, history of diabetes mellitus (DM) and history of high blood pressure were included in the analysis. Logistic regression analysis ascertained the relative predictive ability of these factors. The findings suggested that pre-operative IOP, and the history of panretinal photocoagulation had a statistically-significant influence on the surgical success rate at 1-year follow-up. Table 3 Regression Analysis of Factors Influencing Surgical Success Rate at 1 Year after Surgery β OR (95%CI) P value Gender -0.129 1.274 (0.445–1.735) 0.710 Age 0.014 1.014 (0.985–1.043) 0.350 Diagnosis -0.716 0.488 (0.138–1.727) 0.266 Pre-op VA -2.019 0.133 (0.015–1.204) 0.073 Pre-op IOP -0.033 0.967 (0.938–0.997) 0.030 * Combined with cataract surgery 0.363 1.437 (0.450–4.591) 0.540 PRP history 1.115 3.049 (1.156–8.044) 0.024 * Vitrectomy history -0.321 0.726 (0.230–2.293) 0.585 Cataract surgery history 0.196 1.217 (0.496–2.989) 0.668 DM history -0.582 0.559 (0.217–1.439) 0.228 HBP history 0.226 1.253 (0.622–2.524) 0.528 Table 4 displays the regression analysis of factors influencing the surgical success rate at one year after surgery in NVG patients. Pre-operative IOP and a history of pan-retinal photocoagulation were found to be statistically significant factors that influenced the surgical success rate at one-year follow-up in this subgroup. Table 4 Regression analysis of factors influencing surgical success rate at 1 year after surgery in NVG patients β OR (95%CI) P value Gender -0.335 0.715 (0.281–1.820) 0.482 Age -0.006 1.994 (0.951–1.040) 0.806 Primary disease 1.091 2.974 (0.345–25.638) 0.321 Pre-op VA -3.285 0.038 (0.001–1.789) 0.096 Pre-op IOP -0.043 0.958 (0.920–0.997) 0.035 * Combined with cataract surgery 0.196 1.217 (0.332–4.462) 0.767 PRP history 1.372 3.942 (1.236–12.566) 0.020 * Vitrectomy history -1.384 0.251 (0.054–1.166) 0.078 Cataract surgery history 1.059 0.093 (0.008–10.078) 0.113 DM history -2.373 0.559 (0.217–1.439) 0.057 HBP history 0.531 1.700 (0.695–4.160) 0.245 4. Discussion The AGV has significantly improved the surgical treatment of refractory glaucoma, and this article analysed the long-term surgical success of the AGV implant in the Chinese population. Furthermore, preoperative factors contributing to the surgical success of the AGV and complications related to the procedure were explored. Similar with the current study, Xie, Z., et al. [ 19 ] reported a one-year surgical success rate of AGV as 66.7%. Lai, J. et al. achieved a 73.8% success rate on operated eyes[ 20 ] and Netland, P., et al.[ 21 ] reported a success rate of 73.1%. Our findings revealed overall success rate of 83% at year 1, 74.7% at year 3, and 67.9% at year 5 of follow-up. The success rates for treatment declined over time. Failure rates progressively rose from 17% at year 1 to 32.1% at year 5. Subgroup analysis revealed similar trends across neovascular, secondary, and residual glaucoma at year 1, with complete success rates ranging from 59.3–63.7%, and overall success rates ranging from 81.5–86.4%. In contrast to previous studies, the present research documented a higher success rate at year 1. We hypothesized that this discrepancy is due to the different patient populations examined and relatively larger sample size employed. Echoing the current research, previous studies have investigated the potential factors that might influence the success rates of the AGV implantation. The long-term effects of AGV implantation in 78 eyes were examined by Souza et al.[ 22 ]. Their study indicated 80% success after one year and 49% after five. They said prior glaucoma surgery increased failure risk. A fibrous capsule forms around the endplate after implantation, resisting aqueous flow postoperatively. An increase in fibrosis around the plate causes tube shunt failure, and the use of antimetabolites like mitomycin C or 5-fluorouracil may improve AGV implantation. However, in other investigations, no advantage was seen[ 23 – 25 ]. Due to the heterogeneity of the disease severity, pre-operative state of the patient and study population, and risk factors influencing the efficacy of AGV implantation, the efficacy of AGV implantation remains ambiguous. Özalp, et al. conducted a retrospective study on 60 eyes in Turkey with AGV implantation and found that higher mean preoperative IOP and younger age were risk factors for hypertensive phase development[ 26 ]. Xie et al.’s study in Chinese patients found that age, PRP, complications, and hyphema had an impact on surgical success[ 19 ]. Abe et al. findings from a tertiary hospital in Brazil, African American heritage, and an early hypertensive phase were associated with an elevated chance of failure[ 27 ]. Our findings aligned with some of the previous research, indicating that higher preoperative IOP is a significant factor in the failure of the surgery. Additionally, PRP emerged as a protective element against failure. However, discrepancies were observed in the influence of various other factors, such as patient age and lens status, which might be attributed to differences in racial composition and variations in the inclusion and exclusion criteria across studies. In addition to these findings, some research has centered on the complications associated with the surgical procedure. A retrospective case-control study conducted by Shin et al. suggested that the risk of choroidal detachment following AGV implantation is associated with the etiology of glaucoma, older age, pseudophakia (lens status), and hypertension in a Korean population[ 28 ]. Some studies have compared the efficacy of AGV implantation with that of other surgical methods. Bowden et al. used Ahmed Baerveldt Comparison (ABC) study, Ahmed Versus Baerveldt (AVB) study, and Tube Versus Trabeculectomy (TVT) study data to assess tube shunt operation failure risk variables. Tube shunt failure was predicted by lower preoperative IOP, neovascular glaucoma, AGV implantation, and younger age[ 29 ]. Tran et al. compared AGV implantation to trabeculectomy with mitomycin C in open angle glaucoma patients’ long-term surgical success. Eyes with AGV had a similar success rate after 5 years compared to those with trabeculectomy, defined as an IOP ≤ 21 mmHg and a ≥ 15% drop from baseline (36% and 48%, respectively, p = 0.094). When success was defined as IOP ≤ 18 mmHg and ≥ 20% IOP reduction from baseline, eyes with AGV had a considerably lower success rate (28% vs. 44%, p = 0.024) than eyes with trabeculectomy[ 30 ]. In comparison to similar research, our study encountered several limitations. The study sample had a greater number of male eyes (male = 119 vs. female = 80), perhaps affecting its generalizability. The retrospective design of the study had limitations in assessing outcomes, success rates, and establishing causation of risk factors. We did not incorporate other surgical procedures to further demonstrate the efficacy of AGV implantation. Additionally, an extended follow-up time is required to validate the findings of this investigation. 5. Conclusion AGV implantation is both successful and safe for the treatment of refractory glaucoma. Pre-operative IOP and a history of PRP were found to be statistically significant factors that influenced the surgical success rate at one-year follow-up and decreased over 5 year follow-up. Meticulous execution is essential for clinicians to achieve optimal success in patients undergoing AGV implantation. Declarations Ethics approval and consent to participate : This study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the ethics committee of Tianjin Medical University Eye Hospital (Ethics Number: 2024KY-50). This study was registered in Chinese Clinical Trial Register (ChiCTR2400089879) at September 19, 2024 .Since this is a retrospective study and does not contain any data which can identify individual,ethical approval is exampted.The imformed consent was waived by the ethics committee of Tianjin Medical University Eye Hospital (Ethics Number: 2024KY-50) Consent for publication : Not applicable Competing interests :The authors declare no competing interests. Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Fundings : This study was funded by Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-037A), Tianjin Binhai New Area Health Research Project (2024BWKY18), Tianjin Medical University “Clinical Talent Training 123 Climbing Plan”, and Tianjin Medical University Eye Hospital High-level Innovative Talent Program (YDYYRCXM-E2023-01). Author contribution : The individuals who contributed to the study include those involved in its validation (BY),conceptualization(MYX,XLX),original draft writing(BY,MYX),data curation(BY,MYX),resources(YC,JRL,EEP),investigation(BY,JRL,EEP),formal analysis(YS),software(YS), methodology(JRL,XLX), review approval and supervision of the manuscript (EEP,XLX), funding acquisition(BY). All authors read and approved the final manuscript. Corresponding author:Xioali Xing Acknowledgement: None. References Vision Loss Expert Group of the Global Burden of Disease, Blindness S, Vision Impairment GBD. Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020. Eye (Lond). 2024;38(11):2156–72. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081–90. Chen W, Xu Y, Liu Z, Zhao J. 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Comparison of long-term surgical success of Ahmed Valve implant versus trabeculectomy in open-angle glaucoma. Br J Ophthalmol. 2009;93(11):1504–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Aug, 2025 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 04 May, 2025 Reviews received at journal 02 May, 2025 Reviewers agreed at journal 02 May, 2025 Reviews received at journal 02 May, 2025 Reviewers agreed at journal 01 May, 2025 Reviewers invited by journal 30 Apr, 2025 Editor invited by journal 29 Apr, 2025 Editor assigned by journal 25 Apr, 2025 Submission checks completed at journal 25 Apr, 2025 First submitted to journal 21 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6495663","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":451802967,"identity":"0d4226a7-36ac-49f2-9e60-5b11af6b0c04","order_by":0,"name":"Bo Yu","email":"","orcid":"","institution":"Tianjin Medical University Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Yu","suffix":""},{"id":451802968,"identity":"7b2cda71-9fa5-4d88-8ecd-5c0ab1a6f7f8","order_by":1,"name":"Muyao Xin","email":"","orcid":"","institution":"Tianjin Medical University Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Muyao","middleName":"","lastName":"Xin","suffix":""},{"id":451802969,"identity":"08f16cfe-18b0-4fe7-bce9-1e337d7b0971","order_by":2,"name":"Yu Sun","email":"","orcid":"","institution":"Tianjin Medical University Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Sun","suffix":""},{"id":451802970,"identity":"614ad087-c8ff-4e5c-bb62-9cb85c9b49f4","order_by":3,"name":"Junran Li","email":"","orcid":"","institution":"Tianjin Medical University Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junran","middleName":"","lastName":"Li","suffix":""},{"id":451802971,"identity":"6cb90a3b-f3ee-4b58-8615-6f1d04734fca","order_by":4,"name":"Emmanuel Eric Pazo","email":"","orcid":"","institution":"Tianjin Medical University Eye Hospital","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"Eric","lastName":"Pazo","suffix":""},{"id":451802972,"identity":"8f4d71a0-afd6-43a2-a0a3-4454ff650b93","order_by":5,"name":"Xiaoli Xing","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYFAC5gYGxgYbHn72BqK1MDY2MDakyUj2HCBNy2EbgxsORGowuJHY/uDjjvM8DDcYGD98zCFCi2TPwcbGmWdu8zDObmCWnLmNCC387I2Nzbxtt3mYZQ6wMfMSo4WNmbGx+W/bOR42iQQitYBtYWw7wMNDtBaQX2b2tiXzSPAcbCbOLwY3kg98+NlmZ29/vPngh4/EaEECjA2kqR8Fo2AUjIJRgBsAADeUN8oKkhSTAAAAAElFTkSuQmCC","orcid":"","institution":"Tianjin Medical University Eye Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Xing","suffix":""}],"badges":[],"createdAt":"2025-04-21 11:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6495663/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6495663/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-025-04310-6","type":"published","date":"2025-08-19T16:12:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82299372,"identity":"5c272c14-486b-416e-992c-90d9e02c6727","added_by":"auto","created_at":"2025-05-08 20:34:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85770,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of study design.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6495663/v1/4b3ad3bc441aa7bc3887fb79.png"},{"id":82299369,"identity":"ed72adb2-7bf5-4b75-b7b5-b59e412faca7","added_by":"auto","created_at":"2025-05-08 20:34:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39106,"visible":true,"origin":"","legend":"\u003cp\u003eIntraocular pressure at baseline and follow-up (year-1, year-3, and year-5).\u003c/p\u003e\n\u003cp\u003e(\u003cem\u003et\u003c/em\u003e=20.27, \u003cem\u003eP\u003c/em\u003e﹤0.0001; \u003cem\u003et\u003c/em\u003e=13.89,\u003cem\u003e P\u003c/em\u003e﹤0.0001; \u003cem\u003et\u003c/em\u003e= 6.207,\u003cem\u003e P\u003c/em\u003e﹤0.0001; Sample size: year-1 n=199, year-3 n=76, year-5 n=28)\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6495663/v1/0b453f1ab43c08a79a79c6da.png"},{"id":82300697,"identity":"26164181-5802-4fd1-8390-58c171de6a7c","added_by":"auto","created_at":"2025-05-08 20:50:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":33194,"visible":true,"origin":"","legend":"\u003cp\u003eVisual acuity at baseline and follow-up (year-1, year-3, and year-5).\u003c/p\u003e\n\u003cp\u003e(\u003cem\u003et\u003c/em\u003e=3.064,\u003cem\u003e P\u003c/em\u003e=0.0025; \u003cem\u003et\u003c/em\u003e=1.040, \u003cem\u003eP\u003c/em\u003e=0.3019; \u003cem\u003et\u003c/em\u003e=0.02071, \u003cem\u003eP\u003c/em\u003e=0.9836; Sample size: year-1 n=199, year-3 n=76, years-5 n=28)\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6495663/v1/9193efd27a91d70f93576034.png"},{"id":89847123,"identity":"d720073b-c161-4fe8-b28a-9c0dc3f609dd","added_by":"auto","created_at":"2025-08-25 16:40:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1192648,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6495663/v1/c43950b0-5055-4042-9101-74a7a3459b57.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Long-term outcomes of Ahmed glaucoma valve implantation in glaucoma patients","fulltext":[{"header":"1. Background","content":"\u003cp\u003eGlaucoma is a prominent contributor to permanent vision loss on a global scale, with the potential to impact as many as 111\u0026nbsp;million individuals worldwide by 2040[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It includes a diverse range of disorders that result in permanent loss of vision. These conditions are characterized by a gradual decline in retinal ganglion cells (RGCs) and damage to the optic nerve, in most cases accompanied by increased pressure within the eye[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Due to the gradual deterioration of vision, the common imbalance of illness between the eyes, and the neurological processes that compensate for regions of visual loss, patients typically remain unconscious of their declining eyesight until the latter stages of the disease[\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A staggering proportion of glaucoma cases, remain undiagnosed in low-income and middle-income nations, while around half of the cases go undetected in high-income ones[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Glaucoma, the primary cause of permanent blindness worldwide, affects most patients but does not always result in complete loss of vision. Treatment for glaucoma is successful in reducing the speed at which vision deteriorates. However, there are no therapies available to restore eyesight that has been lost due to glaucoma[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, it is crucial to identify cases and provide efficient therapy. The incidence of glaucoma is expected to significantly increase in the future because to the aging population. Consequently, there will be a greater need for improved identification and treatment of glaucoma to prevent avoidable blindness[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgical intervention is a widely established approach for the management of glaucoma. In concert with technological progress, there has been a significant expansion in the development of intraocular implants, which are designed to efficiently lower intraocular pressure[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The Ahmed glaucoma valve (AGV) is a surgically implanted drainage valve that is designed to regulate the flow of fluid in the eye. It is made up of thin membranes made of silicone elastomer that open and shut in response to changes in intraocular pressure (IOP). This helps to prevent the occurrence of low eye pressure after surgery[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Trabeculectomy and glaucoma drainage device implantation are the predominant glaucoma procedures done on a global scale. While trabeculectomy is considered the most effective method, there is now a growing trend in the use of glaucoma drainage devices. The Ahmed glaucoma valve is a very prevalent glaucoma drainage device that is used extensively on a global scale[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].Therefore, the purpose of this study was to evaluate the long-term effect of AGV on refractory glaucoma patients.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Participants and study design\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective analysis of medical records from patients diagnosed with neovascular glaucoma, secondary glaucoma (excluding neovascular types), and residual glaucoma, all of whom were treated with the AGV (model: FP7, New World Medical Inc., Rancho Cucamonga, CA, USA) at Tianjin Medical University Eye Hospital in China, from January 2016 to June 2023. The study included all patients clinically diagnosed with glaucoma and underwent AGV implantation. Additional inclusion criteria comprised: completed at least one year follow-up assessment, and the absence of serious systemic or mental disorders, aside from primary glaucoma (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Surgical technique\u003c/h2\u003e \u003cp\u003eAll procedures were performed by the same experienced glaucoma surgeon (XXL). The surgical process proceeded as outlined: (i) 2.5 ml of 2% lidocaine (Anhui Changjiang Pharmaceutical Co. Ltd, Wuhu, China) was administered for peribulbar anesthesia. (ii) A suspension wire was fashioned in the corneal limbus, and the bulbar conjunctiva superior to the temple was incised along the corneal limbus, resulting in the formation of a fornix-based conjunctival flap to reveal two rectus muscles. A pocket was created between the episclera and Tenon's capsule using blunt dissection. Following the separation of the fascia, hemostasis was achieved with cauterization. A 4x4 mm scleral flap with a thickness of 50% was created superior to the temple. (iii) The valve tube was irrigated with a balanced saline solution to activate the valve mechanism. The Ahmed valve (model: FP7) was subsequently positioned between the lateral rectus and superior rectus muscles, with a 6\u0026thinsp;\u0026minus;\u0026thinsp;0 suture secured 10 mm posterior to the corneal limbus. (iv) A lateral corneal incision was performed, sodium hyaluronate was administered into the anterior chamber, and an anterior chamber puncture was executed at the corneal limbus beneath the scleral flap. The drainage tube was introduced into the anterior chamber via the puncture site. (v) The sclera flap was secured with 10\u0026thinsp;\u0026minus;\u0026thinsp;0 suture, the drainage tube was anchored and partially ligated with one stitch of 8\u0026thinsp;\u0026minus;\u0026thinsp;0 absorbable suture, and the conjunctival flap was sutured.\u003c/p\u003e \u003cp\u003eSimilar to Mao et al.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], procedure was deemed complete success, if the long-term IOP was \u0026le;\u0026thinsp;21 mmHg without the use of glaucoma medications or additional filtration surgery throughout the entire follow-up period. It was classified as a qualified success, if the IOP\u0026thinsp;\u0026le;\u0026thinsp;21 mmHg was achieved with adjunctive medications, and as a failure, if the IOP exceeded 21 mmHg with medications, if further surgery was necessitated, if there was a loss of vision to no light perception (NLP), or if phthisis bulbi ensued.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data collection\u003c/h2\u003e \u003cp\u003ePreoperative data were extracted from patient records and included age at surgery, gender, eye laterality, best-corrected visual acuity (BCVA), mean IOP over the three months preceding the surgery, history of prior ocular surgeries or laser interventions, specific glaucoma diagnosis and ocular history, and other co-morbidities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS software (version 25.0, SPSS Inc., Chicago, IL). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Preoperative and postoperative data were compared using paired, two-tailed Student\u0026rsquo;s t-tests, while unpaired, two-tailed Student\u0026rsquo;s t-tests were applied for independent continuous variables. Nonparametric variables were analyzed using Chi-square tests. Logistic regression analysis was conducted to identify factors influencing the surgical success rate. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Baseline characteristics\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the baseline characteristics of the patients enrolled in this study. The final analysis encompassed 199 eyes, with a distribution of 119 eyes from male patients and 80 eyes from female patients.Their mean age at the time of surgery was 55.06\u0026thinsp;\u0026plusmn;\u0026thinsp;12.23 years, 42.23\u0026thinsp;\u0026plusmn;\u0026thinsp;17.98 years and 57.09\u0026thinsp;\u0026plusmn;\u0026thinsp;12.06 years for the neovascular, secondary and residual glaucoma respectively. The mean pre-operative IOP was 39.95\u0026thinsp;\u0026plusmn;\u0026thinsp;11.93 mmHg, 33.95\u0026thinsp;\u0026plusmn;\u0026thinsp;12.00 mmHg and 30.80\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84 mmHg among neovascular, secondary and residual glaucoma respectively. The difference between the mean baseline IOP and the IOP at each follow-up point was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean change in VA between the pre-operative and post-operative groups at year-1, year-3 and year-5 were shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Statistically significant changes were observed in year-1 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), however, changes in VA at year-3 and year-5 were not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic data of enrolled patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeovascular glaucoma (n\u0026thinsp;=\u0026thinsp;134)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSecondary glaucoma (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResidual glaucoma (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (64.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (35.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (45.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (Year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.06\u0026thinsp;\u0026plusmn;\u0026thinsp;12.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.23\u0026thinsp;\u0026plusmn;\u0026thinsp;17.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.09\u0026thinsp;\u0026plusmn;\u0026thinsp;12.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEye\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (56.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (37.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (44.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (62.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-op VA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-op IOP (mmHg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.95\u0026thinsp;\u0026plusmn;\u0026thinsp;11.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.95\u0026thinsp;\u0026plusmn;\u0026thinsp;12.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.80\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVitrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (14.0%0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (44.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (63.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (76.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (53.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (83.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (34.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (76.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRVO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUveitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (40.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh myopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOcular trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncertain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe complete success rates among all participants were 60.5% at year 1, 56% at year 3, and 39.3% at year 5. The overall success rates were 83%, 74.7%, and 67.9% at year 5. At year 1, the complete success rates for neovascular glaucoma, secondary glaucoma, and residual glaucoma were 63.7%, 62.8%, and 59.3%, respectively. The overall success rates for these subgroups at year 1 were 86.4%, 86%, and 81.5% respectively.\u003c/p\u003e \u003cp\u003eOne-year post-operative complications between the three groups is illustrated in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Residual glaucoma was experienced by 11.6% in the residual glaucoma group, making is the highest frequency among all the complication while the neovascular and secondary glaucoma group experienced 9.0% and 9.1% respectively among the various groups. Furthermore, malignant glaucoma was only observed in the residual glaucoma group. Complications directly related to the implanted device such as drainage tube exposure was not observed in the residual glaucoma group and drainage tube displacement was not observed in the secondary glaucoma group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost-operation complications within 1 year\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplictions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeovascular glaucoma (n\u0026thinsp;=\u0026thinsp;134)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSecondary glaucoma (n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResidual glaucoma (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChoroidal detachment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrainage tube exposure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrainage tube displacement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMalignant glaucoma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e displays the regression analysis of factors for failure. Factors such as age, gender, diagnosis, pre-operative VA, pre-operative IOP, AGV combined with cataract surgery, history of panretinal photocoagulation (PRP), history of vitrectomy, history of cataract surgery, history of diabetes mellitus (DM) and history of high blood pressure were included in the analysis. Logistic regression analysis ascertained the relative predictive ability of these factors. The findings suggested that pre-operative IOP, and the history of panretinal photocoagulation had a statistically-significant influence on the surgical success rate at 1-year follow-up.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression Analysis of Factors Influencing Surgical Success Rate at 1 Year after Surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.274 (0.445\u0026ndash;1.735)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.014 (0.985\u0026ndash;1.043)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.488 (0.138\u0026ndash;1.727)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-op VA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.133 (0.015\u0026ndash;1.204)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-op IOP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.967 (0.938\u0026ndash;0.997)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCombined with cataract surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.437 (0.450\u0026ndash;4.591)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePRP history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.049 (1.156\u0026ndash;8.044)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.024\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitrectomy history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.726 (0.230\u0026ndash;2.293)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCataract surgery history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.217 (0.496\u0026ndash;2.989)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.559 (0.217\u0026ndash;1.439)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHBP history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.253 (0.622\u0026ndash;2.524)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e displays the regression analysis of factors influencing the surgical success rate at one year after surgery in NVG patients. Pre-operative IOP and a history of pan-retinal photocoagulation were found to be statistically significant factors that influenced the surgical success rate at one-year follow-up in this subgroup.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRegression analysis of factors influencing surgical success rate at 1 year after surgery in NVG patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.715 (0.281\u0026ndash;1.820)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.994 (0.951\u0026ndash;1.040)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrimary disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.974 (0.345\u0026ndash;25.638)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-op VA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-3.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.038 (0.001\u0026ndash;1.789)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-op IOP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.958 (0.920\u0026ndash;0.997)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCombined with cataract surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.217 (0.332\u0026ndash;4.462)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePRP history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.942 (1.236\u0026ndash;12.566)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitrectomy history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.251 (0.054\u0026ndash;1.166)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCataract surgery history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.093 (0.008\u0026ndash;10.078)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.559 (0.217\u0026ndash;1.439)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHBP history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.700 (0.695\u0026ndash;4.160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe AGV has significantly improved the surgical treatment of refractory glaucoma, and this article analysed the long-term surgical success of the AGV implant in the Chinese population. Furthermore, preoperative factors contributing to the surgical success of the AGV and complications related to the procedure were explored. Similar with the current study, Xie, Z., et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] reported a one-year surgical success rate of AGV as 66.7%. Lai, J. et al. achieved a 73.8% success rate on operated eyes[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and Netland, P., et al.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] reported a success rate of 73.1%. Our findings revealed overall success rate of 83% at year 1, 74.7% at year 3, and 67.9% at year 5 of follow-up. The success rates for treatment declined over time. Failure rates progressively rose from 17% at year 1 to 32.1% at year 5. Subgroup analysis revealed similar trends across neovascular, secondary, and residual glaucoma at year 1, with complete success rates ranging from 59.3\u0026ndash;63.7%, and overall success rates ranging from 81.5\u0026ndash;86.4%. In contrast to previous studies, the present research documented a higher success rate at year 1. We hypothesized that this discrepancy is due to the different patient populations examined and relatively larger sample size employed.\u003c/p\u003e \u003cp\u003eEchoing the current research, previous studies have investigated the potential factors that might influence the success rates of the AGV implantation. The long-term effects of AGV implantation in 78 eyes were examined by Souza et al.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Their study indicated 80% success after one year and 49% after five. They said prior glaucoma surgery increased failure risk. A fibrous capsule forms around the endplate after implantation, resisting aqueous flow postoperatively. An increase in fibrosis around the plate causes tube shunt failure, and the use of antimetabolites like mitomycin C or 5-fluorouracil may improve AGV implantation. However, in other investigations, no advantage was seen[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Due to the heterogeneity of the disease severity, pre-operative state of the patient and study population, and risk factors influencing the efficacy of AGV implantation, the efficacy of AGV implantation remains ambiguous. \u0026Ouml;zalp, et al. conducted a retrospective study on 60 eyes in Turkey with AGV implantation and found that higher mean preoperative IOP and younger age were risk factors for hypertensive phase development[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Xie et al.\u0026rsquo;s study in Chinese patients found that age, PRP, complications, and hyphema had an impact on surgical success[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Abe et al. findings from a tertiary hospital in Brazil, African American heritage, and an early hypertensive phase were associated with an elevated chance of failure[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Our findings aligned with some of the previous research, indicating that higher preoperative IOP is a significant factor in the failure of the surgery. Additionally, PRP emerged as a protective element against failure. However, discrepancies were observed in the influence of various other factors, such as patient age and lens status, which might be attributed to differences in racial composition and variations in the inclusion and exclusion criteria across studies.\u003c/p\u003e \u003cp\u003eIn addition to these findings, some research has centered on the complications associated with the surgical procedure. A retrospective case-control study conducted by Shin et al. suggested that the risk of choroidal detachment following AGV implantation is associated with the etiology of glaucoma, older age, pseudophakia (lens status), and hypertension in a Korean population[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Some studies have compared the efficacy of AGV implantation with that of other surgical methods. Bowden et al. used Ahmed Baerveldt Comparison (ABC) study, Ahmed Versus Baerveldt (AVB) study, and Tube Versus Trabeculectomy (TVT) study data to assess tube shunt operation failure risk variables. Tube shunt failure was predicted by lower preoperative IOP, neovascular glaucoma, AGV implantation, and younger age[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Tran et al. compared AGV implantation to trabeculectomy with mitomycin C in open angle glaucoma patients\u0026rsquo; long-term surgical success. Eyes with AGV had a similar success rate after 5 years compared to those with trabeculectomy, defined as an IOP\u0026thinsp;\u0026le;\u0026thinsp;21 mmHg and a\u0026thinsp;\u0026ge;\u0026thinsp;15% drop from baseline (36% and 48%, respectively, p\u0026thinsp;=\u0026thinsp;0.094). When success was defined as IOP\u0026thinsp;\u0026le;\u0026thinsp;18 mmHg and \u0026ge;\u0026thinsp;20% IOP reduction from baseline, eyes with AGV had a considerably lower success rate (28% vs. 44%, p\u0026thinsp;=\u0026thinsp;0.024) than eyes with trabeculectomy[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In comparison to similar research, our study encountered several limitations. The study sample had a greater number of male eyes (male\u0026thinsp;=\u0026thinsp;119 vs. female\u0026thinsp;=\u0026thinsp;80), perhaps affecting its generalizability. The retrospective design of the study had limitations in assessing outcomes, success rates, and establishing causation of risk factors. We did not incorporate other surgical procedures to further demonstrate the efficacy of AGV implantation. Additionally, an extended follow-up time is required to validate the findings of this investigation.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eAGV implantation is both successful and safe for the treatment of refractory glaucoma. Pre-operative IOP and a history of PRP were found to be statistically significant factors that influenced the surgical success rate at one-year follow-up and decreased over 5 year follow-up. Meticulous execution is essential for clinicians to achieve optimal success in patients undergoing AGV implantation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003eThis study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the ethics committee of Tianjin Medical University Eye Hospital (Ethics Number: 2024KY-50). This study was registered in Chinese Clinical Trial Register (ChiCTR2400089879) at September 19, 2024 .Since this is a retrospective study and does not contain any data which can identify individual,ethical approval is exampted.The imformed consent was waived by the ethics committee of Tianjin Medical University Eye Hospital (Ethics Number: 2024KY-50)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e:The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u003c/strong\u003e: This study was funded by Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-037A), Tianjin Binhai New Area Health Research Project (2024BWKY18), Tianjin Medical University \u0026ldquo;Clinical Talent Training 123 Climbing Plan\u0026rdquo;, and Tianjin Medical University Eye Hospital High-level Innovative Talent Program (YDYYRCXM-E2023-01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e: The individuals who contributed to the study include those involved in its validation (BY),conceptualization(MYX,XLX),original draft writing(BY,MYX),data curation(BY,MYX),resources(YC,JRL,EEP),investigation(BY,JRL,EEP),formal analysis(YS),software(YS), methodology(JRL,XLX), review approval and supervision of the manuscript (EEP,XLX), funding acquisition(BY). \u0026nbsp;\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eCorresponding author:Xioali Xing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVision Loss Expert Group of the Global Burden of Disease, Blindness S, Vision Impairment GBD. Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020. Eye (Lond). 2024;38(11):2156\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen W, Xu Y, Liu Z, Zhao J. Global, regional and national burden of Glaucoma: an update analysis from the Global Burden of Disease Study 2019. Int Ophthalmol. 2024;44(1):234.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasavarajappa D, Galindo-Romero C, Gupta V, Agudo-Barriuso M, Gupta VB, Graham SL, Chitranshi N. Signalling pathways and cell death mechanisms in glaucoma: Insights into the molecular pathophysiology. Mol Aspects Med. 2023;94:101216.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuigley HA. Neuronal death in glaucoma. Prog Retin Eye Res. 1999;18(1):39\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKang JM, Tanna AP. Glaucoma. Med Clin North Am. 2021;105(3):493\u0026ndash;510.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStein JD, Khawaja AP, Weizer JS. Glaucoma in Adults-Screening, Diagnosis, and Management: A Review. JAMA. 2021;325(2):164\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamulu PY, West SK, Munoz B, Jampel HD, Friedman DS. Driving cessation and driving limitation in glaucoma: the Salisbury Eye Evaluation Project. Ophthalmology. 2009;116(10):1846\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Jin G, Fan M, Lin Y, Wen X, Li Z, Zeng P, Zheng D, Lan Y. Time trends and heterogeneity in the disease burden of glaucoma, 1990\u0026ndash;2017: a global analysis. J Glob Health. 2019;9(2):020436.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSafitri A, Konstantakopoulou E, Hu K, Gazzard G. Treatment expectations in glaucoma: what matters most to patients? Eye (Lond). 2023;37(16):3446\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStorgaard L, Tran TL, Freiberg JC, Hauser AS, Kolko M. Glaucoma Clinical Research: Trends in Treatment Strategies and Drug Development. Front Med (Lausanne). 2021;8:733080.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamji S, Nagi G, Ansari AS, Kailani O. A systematic review and meta-analysis of randomised controlled trials in the management of neovascular glaucoma: absence of consensus and variability in practice. Graefes Arch Clin Exp Ophthalmol. 2023;261(2):477\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSlettedal JK, Traustadottir VD, Sandvik L, Ringvold A. The prevalence and incidence of glaucoma in Norway 2004\u0026ndash;2018: A nationwide population-based study. PLoS ONE. 2020;15(12):e0242786.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevin AM, Sheybani A. Glaucoma surgical procedures under development. Curr Opin Ophthalmol. 2024;35(2):111\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatil TS, Mani B, Balekudaru S, George RJ, Lingam V. Effect of immediate shallow anterior chamber after Ahmed glaucoma valve implantation on intermediate-term intraocular pressure control. Indian J Ophthalmol. 2022;70(8):2915\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman AL, Hill R, Wilson MR, Choplin N, Kotas-Neumann R, Tam M, Bacharach J, Panek WC. Initial clinical experience with the Ahmed Glaucoma Valve implant. Am J Ophthalmol. 1995;120(1):23\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArikan G, Gunenc U. Ahmed Glaucoma Valve Implantation to Reduce Intraocular Pressure: Updated Perspectives. Clin Ophthalmol. 2023;17:1833\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMao Z, Guo X, Zhong Y, Liu X. Surgical outcomes of Ahmed glaucoma valve implantation in patients with glaucoma secondary to iridocorneal endothelial syndrome. Eye (Lond). 2021;35(2):608\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie Z, Liu H, Du M, Zhu M, Tighe S, Chen X, Yuan Z, Sun H. Efficacy of Ahmed Glaucoma Valve Implantation on Neovascular Glaucoma. Int J Med Sci. 2019;16(10):1371\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai JS, Poon AS, Chua JK, Tham CC, Leung AT, Lam DS. Efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucoma. Br J Ophthalmol. 2000;84(7):718\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNetland PA. The Ahmed glaucoma valve in neovascular glaucoma (An AOS Thesis). \u003cem\u003eTrans Am Ophthalmol Soc\u003c/em\u003e 2009, 107:325\u0026ndash;342.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSouza C, Tran DH, Loman J, Law SK, Coleman AL, Caprioli J. Long-term outcomes of Ahmed glaucoma valve implantation in refractory glaucomas. Am J Ophthalmol. 2007;144(6):893\u0026ndash;900.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYazdani S, Mahboobipour H, Pakravan M, Doozandeh A, Ghahari E. Adjunctive Mitomycin C or Amniotic Membrane Transplantation for Ahmed Glaucoma Valve Implantation: A Randomized Clinical Trial. J Glaucoma. 2016;25(5):415\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta VP, Azuara-Blanco A, Netland PA, Lesk MR, Arcieri ES. Efficacy and safety of adjunctive mitomycin C during Ahmed Glaucoma Valve implantation: a prospective randomized clinical trial. Ophthalmology. 2004;111(6):1071\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Mobarak F, Khan AO. Two-year survival of Ahmed valve implantation in the first 2 years of life with and without intraoperative mitomycin-C. Ophthalmology. 2009;116(10):1862\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzalp O, Ilguy S, Atalay E, Simsek T, Yildirim N. Risk factors for hypertensive phase after Ahmed glaucoma valve implantation. Int Ophthalmol. 2022;42(1):147\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbe RY, Tavares CM, Schimiti RB, Vasconcellos JP, Costa VP. Ahmed Glaucoma Valve Implantation for Refractory Glaucoma in a Tertiary Hospital in Brazil. \u003cem\u003eJ Ophthalmol\u003c/em\u003e 2015, 2015:850785.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin DY, Jung KI, Park HYL, Park CK. Risk Factors for Choroidal Detachment After Ahmed Valve Implantation in Glaucoma Patients. Am J Ophthalmol. 2020;211:105\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBowden EC, Choudhury A, Gedde SJ, Feuer WJ, Christakis PG, Savatovsky E, Han Y, Ahmed IIK, Budenz DL, Abc AVB, et al. Risk Factors for Failure of Tube Shunt Surgery: A Pooled Data Analysis. Am J Ophthalmol. 2022;240:217\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTran DH, Souza C, Ang MJ, Loman J, Law SK, Coleman AL, Caprioli J. Comparison of long-term surgical success of Ahmed Valve implant versus trabeculectomy in open-angle glaucoma. Br J Ophthalmol. 2009;93(11):1504\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Glaucoma, Ahmed glaucoma valve, Neovascular glaucoma, Secondary glaucoma, Residual glaucoma, Glaucoma surgical success rate","lastPublishedDoi":"10.21203/rs.3.rs-6495663/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6495663/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation in treating refractory glaucoma and analyze the factors influencing the surgical success rate.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 5-year retrospective analysis was conducted on 199 patients with neovascular glaucoma, secondary glaucoma (excluding neovascular types), and residual glaucoma treated with AGV, model FP7. Preoperative and postoperative data, including intraocular pressure (IOP), visual acuity, and surgical outcomes, were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eComplete Success rates were 60.5%, 56%, and 39.3% at years 1, 3, and 5, respectively. Overall success rates were 83%, 74.7%, and 67.9% at the same intervals. Visual acuity (VA) showed statistically significant improvement at year 1 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but changes at years 3 and 5 were not significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Low preoperative IOP and the history of pan-retinal photocoagulation (PRP) were identified as protective factors contributing to the success of surgical outcomes at year-1.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAGV implantation is a safe and effective treatment for neovascular glaucoma. Preoperative IOP and a history of PRP significantly influence surgical success at one year, with success rates declining over 5 years. Careful surgical execution is crucial for achieving optimal outcomes.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eThis retrospective study was registered at the registered in Chinese Clinical Trial Register (ChiCTR2400089879).\u003c/p\u003e","manuscriptTitle":"Long-term outcomes of Ahmed glaucoma valve implantation in glaucoma patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-08 20:33:56","doi":"10.21203/rs.3.rs-6495663/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-05T03:28:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-02T18:57:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68854255685757163668683526481040272786","date":"2025-05-02T10:45:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-02T07:05:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119699482948818105795016596879412465402","date":"2025-05-01T10:07:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-01T03:37:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-29T08:24:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-25T05:01:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-25T04:58:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-04-21T11:27:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"92e6f368-152d-4f86-9a0e-2fca6a51cb41","owner":[],"postedDate":"May 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:31:12+00:00","versionOfRecord":{"articleIdentity":"rs-6495663","link":"https://doi.org/10.1186/s12886-025-04310-6","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2025-08-19 16:12:59","publishedOnDateReadable":"August 19th, 2025"},"versionCreatedAt":"2025-05-08 20:33:56","video":"","vorDoi":"10.1186/s12886-025-04310-6","vorDoiUrl":"https://doi.org/10.1186/s12886-025-04310-6","workflowStages":[]},"version":"v1","identity":"rs-6495663","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6495663","identity":"rs-6495663","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}